My fertility journey is not typical. I have not spent years “trying”. In fact, I have spent years trying NOT to get pregnant!

My husband has two daughters – AND a vasectomy. So getting pregnant was a known challenge. Luckily, I like challenges. We went to an infertility specialist, who told us that reversal was NOT an option for us, and that IVF was our ONLY option. A bunch of testing later, they diagnosed me with diminished ovarian reserve and suspected endometriosis and recommended laparoscopic surgery. I had not even TRIED to get pregnant. I didn’t want surgery; I just wanted a baby. The only problem I was aware of was getting my husband’s sperm. Or so I thought.

I went for my egg harvest (a procedure to retrieve my eggs for IVF). I came out of my Propofol-haze to find out I had eight eggs. Only eight. The downhill spiral started before the Propofol had worn off. What if I do have a problem? What if I have diminished ovarian reserve or endometriosis? Should I have had the surgery? All of these questions started running through my head as I waited five long days for my transfer to occur.

On our transfer date, we were ecstatic. It was October. We were “going to put a pumpkin in my belly”. Our plan was to transfer two embryos, until we went in to the office and found out we in fact ONLY had two embryos. Well there were two other ones that were in morula phase but needed to progress to blastocyst. We looked at each other, without much discussion and said, “Okay we have two. We will have two more once they grow. Let’s put in these two.” And we did. I spent the day on the floor with my legs against the wall trying to encourage those two embryos to make a home in my uterus. All the while I was wondering, “Was the doctor was right? Did I have my own reproductive problems? Had I managed to get to 31 years of age without a child because I am infertile?”

I hadn’t heard anything about my two other embryos, so I emailed my nurse to call me with the results. She didn’t call. She sent me an email: No frozen embryos L.

Sad face – like the one with the colon and the parentheses…yes that. Breaking bad news is always a challenge. I break bad news almost every shift in the emergency department. An email with a sad face to a woman jacked up hormones was not the best approach. I now had two embryos inside me that were my only chance of getting pregnant, and a 60% chance of success at that.

Ten days later, we did a home pregnancy test. It was positive. We were overjoyed – for a short time. The next day my blood pregnancy test came back: 49. My nurse called and explained that it was lower than they would expect. I agreed to a 48-hour repeat. The next day, I started bleeding on my overnight shift. My repeat count was 98. EXACTLY doubled. I was still bleeding. My nurse called again – wanted to know if I want to keep repeating beta quants every two days or just wait for my six-week ultrasound. I did NOT want to be the patient I see in the ER getting repeat quants. In fact, I didn’t want to be the patient at all. So I said “No!” and I waited until my six-week ultrasound.

On my ultrasound day, I had started to feel pregnant. I had started to believe I could be pregnant. But as soon as the transvaginal probe went in, I could see the clear stripe of my uterus uninterrupted by any collections of fluid. It was utterly empty. Immediately, the tears crept in the corners of my eyes. My doctor scanned out to the left, and there it was – a gestational sac, a yolk sac, no fetal pole, no heartbeat. I had an ectopic pregnancy. That diagnosis I was always eager to make in others, I now made for myself. My doctor looked at me and said the most honest thing she could say, “I am so sorry. You probably diagnose these way more than I do. It’s extremely rare with IVF, less than 1%.” Yes, I do diagnose them more than she does. And yes, I am the 1%.

My infertility journey didn’t end with an ectopic. I underwent multiple other rounds of IVF, eventually laparoscopic surgery, and I am now currently starting my fifth round of injections and then hopefully my third egg retrieval.

I share my very personal story, because though I was diagnosed as the 1% undergoing fertility treatments with an ectopic, my diagnosis of infertility as a woman in medicine is not rare. I am NOT alone.

For the general population, the infertility risk is approximately 12.1% according to CDC data. Women around the world with infertility state that they are the 1 in 8. As women in medicine, we have an INCREASED RISK of infertility. Our risk is 24.1% for infertility, which means that for women in medicine, ONE IN FOUR of us will struggle with infertility.

Many will say it is because we attempt conception at an older age, and yes that is part of it. But it is NOT the whole story. A study in Hungary looked at over 3000 female physicians and compared them to an age adjusted control group of professional women, other women who delayed child-birthing for their education and careers. The study found that women in medicine STILL had a statistically significant increase in infertility rates, even compared with their professional colleagues of the same age.

So where do we go from here?

First, we have to start the conversation. We have to start telling our stories and raise awareness about physician infertility. As physicians, we can do so much to erase the stigma around infertility, and to raise awareness in our own professional groups. It is uncomfortable, but change can only start by working through discomfort.

Second, we need to counsel and protect the young women in medical school and early residency that will be joining our ranks. We need to caution them in advance. I never thought 31 would be too old. We need to start the conversation so that the women coming behind us are better informed that I was; so that they know their risks – the risks I didn’t know – and can make decisions accordingly.

Finally, we NEED more data and better data. Data will allow us to create policies to protect women in medicine, for example: policies to not only allow, but to actually support women who want to have children during their training, whether medical school or residency.

In the meantime, as we wait for more data and better policies, as I wait for another round of IVF and the possibility of pregnancy, I will continue to tell my story to raise awareness about physician infertility. I invite you to join me – #SayTheFWord and tell your story.

I have had my first preganancy two months after my marraige. But it ended in a misscaraige. Then I struggled for three years. Which I had three rounds of Clomid. One ending with a big ovarian cyst. A tubal latency test. Lots of prayers going for holy pilgrimage. And finally got pregnant on my own.. may b effect of treatment I had taken earlier. But not in the cycle i had conceived . now I am trying again for the last 2 yrs and so.. tubal patenvy showed resistance on right side. Which was cleared. Took two rounds of Clomid… Read more »

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6 months ago

Guest

Vijeta

I am a physician and we started trying at 31 years and did not get pregnant. At 32 started my first ivf round last month and the cycle had to be cancelled as I did not respond properly. I also have diminished ovarian reserve. Waiting to start cycle number 2. I hope you get your baby soon.

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5 months ago

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Marcia Glass

Thank you!

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5 months ago

Guest

S Klamer, MD

Dr Sami David in NYC is the best fertility specialist. As an MD myself I would advise anyone to go to him before agreeing to expensive stressful highly medicated treatment plans. He has a very thorough evidence based approach that has yielded success in many difficult cases.

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5 months ago

Guest

Tamara Moores Todd

Talking about the F word is hard, but I bring it up more and more than I used to. I’m 3 years out of residency in emergency medicine, 31 years old, and on my first REI visit at age 29 the lovely REIs gently told me that donor eggs might be my only option. My heart broke that day. I was not even in “having kids mode” but got checked because I started having irregular periods that I had attributed to stress from my first attending job. Premature Ovarian Failure and Diminished Ovarian Reserve doesn’t quite describe the emotions that… Read more »

Thank you for sharing your journey and trying to draw awareness to the struggle. I was diagnosed with severely diminished ovarian reserve at age 30 as well. Fresh from completing residency and getting married. 3 years later and 4 miscarriages later and I still have nothing to show for it. I have often wondered if my journey would’ve been different had I not gone into medicine. I do think it is important to reach out to our sisters in medicine early on to consider these possibilities as early as possible and to advocate for earlier testing for women in general.… Read more »

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5 months ago

Guest

tick toc

It is unfortunately a difficult problem for professional women, including those in the medical profession, navigating the fine balance between career building and success against their biological clock.
Albeit a different topic, with all the efforts and heartache you have invested into this long and difficult journey, have you considered adoption. There are so many children, babies and newborns in need for a loving family and home.

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5 months ago

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Natalie Rudder

Thank you for sharing this.

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5 months ago

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Corina Fratila

This should be part of the informed consent that Pamela Wible, MD is talking about, for getting in medical school.
1. Increased risk of death (the profession with the highest suicide risk)
2. Infertility

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5 months ago

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Terri C.

Is there a theory as to why? BTW, Dentists have the highest rate of suicide.

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5 months ago

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Kim

Looking for a reference for this statistic:

“Our risk is 24.1% for infertility, which means that for women in medicine, ONE IN FOUR of us will struggle with infertility.”

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5 months ago

Guest

Stacy

I have had 8 miscarriages and one living child. The struggle is real. Thanks sharing your story. I know that’s not easy.

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5 months ago

Guest

Sim

It doesn’t help that as residents or fellows our programs don’t always offer insurance that covers fertility….we need to talk about this too! :/

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5 months ago

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Alice J Tang

Thank you for so bravely sharing your story – so important for women physicians not to have to suffer in silence

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5 months ago

Guest

Dr. HWB

Thank you for sharing. I feel your pain and am sharing my story because you asked us to speak out about them. I am 40 and had my first baby at 36 with no issue – conceived within 3 months of pulling my own IUD 🙂 Started trying again at 38 and after six months, initiated the work up, which revealed that I had decreased ovarian reserve in spite of regular periods. Tried an oral medicine called letrozole for about 4 months, conceived, and had a miscarriage at 7 weeks. Then started a year of hellish cycles of injectable hormones… Read more »

#SaytheFword I had my own journey with infertility. My eyes teared up when you said you had an ectopic- in fact I remember my quant doubled exactly too and when yours did as well, I wondered.. anyway my husband and I tried for 5 years… we did acupuncture (stuck with it the whole time actually!), went to naturopaths, tried herbs, home fertility testing, many supplements for low sperm count. We did so many rounds of IUI I lost count- we continued because I got pregnant with my first round and unforunately that ended in an ectopic pregnancy. We finally saved… Read more »

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5 months ago

Guest

Long Journey

Yup. Started trying to conceive at 30, was told had ovaries of a 45 year old. Multiple rounds of IVF…sometimes with only 1 egg or 2 at retrieval, transfers, natural cycle IVF, miscarriages of transferred embryos, chromosomal, D&C etc, lucky lucky to get 2 beautiful and healthy kids out of it by age 40. 10 years of trying to have babies. What a long haul….amidst call, residency, fellowship, research and full time work/call, academic endeavors and no room to share with those around me for fear of being given some sort of advantage. Guess the one thing medicine caused was… Read more »

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5 months ago

Guest

Naomi Bardach

I wonder if there is something about sleep deprivation/disrupted sleep cycles that is part of the explanation for women in medicine in particular, more so than women in other professional careers with long hours and delayed child bearing.

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5 months ago

Guest

Rachel

Thanks for sharing this difficult story. I started trying to get pregnant at 32. My first pregnancy was after only 2 months of trying and ended in miscarriage. Then I tried for a year, and with femara got pregnant again and again miscarried. Then we tried 6 more months of femara without success and then did 6 months of IUIs without success. THEN did three rounds of IVF with 3 genetically normal embryos … without success. Then we started down the adoption pathway, which is also NOT EASY especially after going through years of infertility treatment. Then unexpectedly, after 4.5… Read more »

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5 months ago

Guest

Katy B (Urgent Care physician, MA)

Thank you for sharing your story. It is a very important topic to be raised, and such a personal one. I applaud your courage. Indeed, we need to help our younger colleagues to navigate this field and hopefully not have to struggle with those odds.

I struggled with similar issues in residency and after. For me, it came out all right in the end: my marriage survived, I have two children and count myself very lucky. But it is a sad and stressful fight in our already plenty stressful lives.

I wish you the best of luck with IVF!

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5 months ago

Guest

Dr. Butts

Thank you for sharing and raising awareness about this very important issue!!

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5 months ago

Guest

K M Kowalski

I am in the 24%. I can’t help but be suspicious of our exposure as healthcare providers to toxins. There is a lot of data on on triclosan’s effects on fertility which I’m sure has been in the industrial soap I washed my hands with with 20+ times a day, then there was the 5 months bathed in formaldehyde in the anatomy lab. Likely there is some cumulative toxicity of our “sterile” environment.

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5 months ago

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Kristina Lehman

I am in the 1 in 4. Waited until after residency due to perceived issues during residency. Took 3 years to get my first and fortunately one try with clomid/HCG/IUI for my 2nd. We do owe it to the med students and residents to warn them. I started a “mom in training” support program at my institution and am very active in Dr. MILK to support physicians with breastfeeding. Have to keep talking about it!!!

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5 months ago

Guest

Megh

Thank you for sharing! I feel your pain. I managed to get to know our Infertility Clinic all too well over the past few years…in spite of having normal tubes, normal uterus, normal 28-day cycle, and better ovarian reserve than I deserve at my age. You see, I put off having kids (thinking I was soooo perfectly healthy, and I wanted to be a good surgeon/ good colleague/ good Naval officer, something like that) until my husband’s familial endocrine issues caught up with him. He did everything he could, but after 18 months of Clomid for him, we tried 5… Read more »

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5 months ago

Guest

Penny

Thank you all so much for sharing your experiences. I really wish when I was going through all this a support system was in place! I too struggled with infertility. We started trying to conceive when I was 3 years into practice. My husband was born with what we called “trojan man” sperm – 100% antibody coating preventing fertilization. After several “washings” with insemination, we failed to conceive. This of course took about a year. Then the assisted IVF x 5 cycles using my harvested eggs. Then, a failed adoption – yes we had a sweet little girl for 6… Read more »

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5 months ago

Guest

Rebecca

I had my first child before I went to medical school, then out of residency, working and getting well into my 30s, I decided I wanted another but try as we may it was not to be. Older yes, but my mother had my brother and me at 39 and 41. I chose not to do IVF and have subsequently adopted too many dogs and cats. I wonder if it is the sustained stress or the chemicals we are around…

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5 months ago

Guest

Lisa C.

I struggled with infertility starting at the age of 33. After more than a year of trying to get pregnant, we sought out fertility services. I went through several rounds of insemination before moving to IVF. The first attempt was a total failure, 6 embryos, all arrested development by day 5, no transfer. The doctor suggested I use an egg donor… we moved on to a second opinion, and started seeing an amazing acupuncturist who helped me clean up my diet and started me on some supplements. I was willing to try anything at this point. I went to another… Read more »

Currently waiting to be taken back for my 3rd surgery for endometriosis in the last year and a half for a PSN. Let’s hope I come out of this pain-free.

By Shino Lahsra

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2 months ago

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